Neuropathic Heel Ulcer

Diabetic foot ulcer is one of the main complications of diabetes mellitus which often leads to non traumatic lower extremity amputations in many of the patients. It is characterized by an open wound that forms on the foot. About 15% of all diabetic patients contract this condition and a majority of leg amputations are caused by diabetic foot ulcer. Early detection of this condition and appropriate treatment can help to prevent amputations to a great extent.

Causes of diabetic foot ulcer

Diabetic foot ulcer can be caused by a variety of reasons, the most common one being trauma to the foot caused by diabetes mellitus. Given below are some of the examples of trauma that can occur on your foot which may finally lead to foot ulcer.

- Laceration of the foot

- Wounds caused by wearing ill-fitting shoes

- Untreated calluses

- Insect bite

- Deep cuts or wounds

- Burn injury

Apart from trauma, diabetic foot ulcer can also be caused by factors such as

- Peripheral neuropathy – Diabetes may sometimes cause damage to the peripheral nerves leading to the malfunctioning of the motor, sensory and autonomic nerves. This condition is considered to the major causative factor of diabetic foot ulcers.

- Peripheral vascular disease – This is yet another condition seen commonly in patients with diabetes which causes decreased blood supply to the lower parts of the body leading to tissue ischemia. About 35% cases of diabetic foot ulcers are caused by peripheral vascular disease.

- Infection – An injury or wound in the foot can cause bacteria to enter the wound and lead to an infection. The infection may be just localized to the surface of the skin (Superficial), spread to the deeper skin layers (Cellulitis) or spread to the underlying bone tissues (Osteomyelitis). Since in diabetic patients, the normal wound healing process does not take place effectively, there is always the possibility that a wound which starts as a superficial one may go on to become Osteomyelitis. At this stage, amputation of the foot may be the only option in many cases.

Diabetic Foot Ulcer

Symptoms of foot ulcer

A person suffering from diabetic foot ulcer may experience the following signs or symptoms.

- Pus or foul odor coming from the ulcer

- Increased size of the ulcer

- Changes in the appearance and texture of the skin

- Thick, yellowish or curled toenails

- New feeling of numbness in the feet

- Weakness of the foot or having trouble moving them

- Fever and chills

- Redness and swelling in the foot

- Frequent occurrence of muscle pain or muscle cramps while walking

Treatment of diabetic foot ulcer

A proper diagnosis and appropriate treatment of diabetic foot ulcers is highly critical for preventing several serious complications as well as to reduce the risk of amputation of the affected foot. A multidisciplinary assessment of the situation is required from health care professionals from different medical disciplines such as diabetologist, orthotist, neurologist, podiatrist and vascular surgeon. The primary goal of the treatment is to close the wound, relieve the pressure on the foot (off-loading), elimination of infection and management of ischemia.

Prevention of diabetic foot ulcer

Once the diabetic foot ulcer is treated, it is extremely important to take steps to prevent its recurrence. The risk of amputation is found to increase with each recurrence and therefore preventing the disease is of utmost importance. Diabetic foot ulcer can be prevented by

- Controlling diabetes to reduce the risk of vascular diseases

- Using pressure-relieving shoes

- Avoiding the use of ill-fitting shoes

- Following proper foot hygiene

- Proper foot care and management of even minor injuries to the foot

Conclusion

Recognition of risk factors and understanding the importance of foot hygiene, nail care and the use of proper footwear is vital, in order to reduce the risk of an injury that can lead to the formation of diabetic foot ulcer. This may ultimately lead to a decrease in lower extremity amputations due to foot ulcers. Check your foot for redness, blisters, cuts, cracks, or ulcers, and if at all any such symptoms are noticed, consult your doctor and start treatment immediately.